AB1022 EARLY DIAGNOSIS OF SPONDYLOARTHRITIS AND OTHER RHEUMATIC DISEASES IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: A PROSPECTIVE STUDY BASED ON A SCREENING QUESTIONNAIRE AND EARLY REFERRAL TO THE RHEUMATOLOGIST
Authors: M. C. Miceli, S. Renna, A. Orlando, G. Provenzano
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Patients (pts) with inflammatory bowel disease (IBD) frequently disclose muscoloskeletal (MSK) symptoms. About 15-20% of these pts are affected by spondyloartritis (SpA) and almost 50% have mechanical back pain and non-inflammatory arthralgyas [1]. Notably, up to 30% of them may have fibromyalgic syndrome (FMS) [2], although there are limited data on this issue. Early and accurate diagnosis of articular involvement in IBD pts is crucial to allow a personalized therapeutic approach and mostly an unmet need. <h3>Objectives</h3> Early diagnosis of axial-SpA (Ax-SpA) and peripheral SpA (p-SpA) in IBD pts with MSK symptoms and definition of other rheumatologic causes of pain in these complex pts. <h3>Methods</h3> A prospective cohort of IBD outpatients without a previous clear diagnosis of rheumatic disease was evaluated with the self-administered DETAIL questionnaire [3], which has been recently validated as a useful screening tool for early detection of SpA in IBD [4]. Pts with at least 3 out of 6 points of the score (the risk cohort) underwent a full clinical rheumatological evaluation and ultrasonographic (US) assessment of 6 enthesis (according to MASEI score). Pts fulfilling ASAS classification criteria were diagnosed as having p-Spa or ax-Spa. Rheumatoid arthritis (RA) and FMS were also diagnosed according to ACR 2010 criteria. <h3>Results</h3> 660 IBD pts were administered the questionnaire. Ninetytwo pts (14%) were selected for rheumatological evaluation: 69/92 pts (75%) were female, the median age was 48 (±12.7) years and the mean BMI was 23.8 (±3.7). Sixtyseven pts (73%) were affected by Crohn disease, 23 pts (25%) by ulcerative colitis and 2 pts (2%) had indeterminate colitis. The median disease duration was 11.6 (±9.3) years. Fiftytwo pts (56,5%) were in biologic therapy (77% with anti-TNF, 15,3% con Vedolizumab and 7,7% with Ustekinumab). Overall, 38/92 pts (41%) were classified as having arthritis [25 (66%) p-SpA, 11 (23%) ax-SpA, 3 (1%) RA. Notably, in 9 of these pts coexisted FMS. 54/92 pts (58.6%) of the risk cohort did not fullfill arthritis classification criteria: 32 pts (60%) were diagnosed as having osteoarthritis or aspecific arthralgias and 22 pts (41%) fullfilled FMS criteria. Notably, in the whole risk cohort there were 31 pts (41%) with FMS. Concerning US assessment, the statistical analysis only showed marginal correlation between MASEI score and ax-SpA diagnosis (p=0.086) but no correlation with p-SpA. <h3>Conclusion</h3> This study confirm that the DETAIL questionnaire may be a useful screening tool in order to select IBD pts needing rheumatologic evaluation and get an early diagnosis of SpA. However, our data also show that IBD pts with MSK symptoms often have other non-inflammatory rheumatic diseases. Notably, in our series US did not represent a sensitive method in identifying pts with SpA. <h3>References</h3> [1]Malaty HM, Lo GH, Hou JK. Characterization and prevalence of spondyloarthritis and peripheral arthritis among patients with inflammatory bowel disease. Clin Exp Gastroenterol. 2017 Sep 27;10:259-263. [2]Palm O, Moum B, Jahnsen J et al. Fibromyalgia and chronic widespread pain in patients with inflammatory bowel disease: a cross sectional population survey. J Rheumatol. 2001 Mar;28(3):590-4. [3]Di Carlo M. et al. The DETection of Arthritis in Inflammatory boweL diseases (DETAIL) questionnaire: development and preliminary testing of a new tool to screen patients with inflammatory bowel disease for the presence of spondyloarthritis. Clinical Rheum. 2018 Apr;37(4):1037-1044. [4]Devis Benfaremo 1, et al b. Multicenter Validation of the DETAIL Questionnaire for the Screening of Spondyloarthritis in Patients With Inflammatory Bowel Diseases. Journal of Rheumatology 2021 Feb;48(2):179-187. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Maria Concetta Miceli Grant/research support from: Sanofi, Novartis,UCB, Roche, BMS, Lilly., Sara Renna Grant/research support from: AbbVie, MSD, Takeda and Janssen, Ambrogio Orlando Speakers bureau: AbbVie, MSD, Janssen, Pfizer, Takeda Pharmaceuticals, Grant/research support from: AbbVie, MSD, Sofar, Chiesi, Janssen, Pfizer, and Takeda Pharmaceuticals., Giuseppe Provenzano Grant/research support from: Abbvie, Alfasigma, Amgen, BMS, Fresenius Kabi, Galapagos, GSK, Lilly, Pfizer.